Faculty of Medicine, Al-Quds University, Main Campus, P.O. Box 89, Abu Dis, Palestine.
Al-Ahli Hospital, Hebron, Palestine.
J Med Case Rep. 2022 Jun 9;16(1):231. doi: 10.1186/s13256-022-03449-w.
Hepatitis A virus infections are mostly asymptomatic or mildly symptomatic, and generally this disease has a benign course and resolves spontaneously. However, intrahepatic and rarer extrahepatic manifestations can complicate typical cases of acute hepatitis. Pleural effusion is an extremely rare extrahepatic entity with 20 cases reported in literature.
We report herein a recent case of both pleural effusion and ascites accompanying hepatitis A infection in a 5-year-old middle eastern child, diagnosed using serological testing and imaging studies, who was treated with supportive management with full resolution after 2 weeks. In addition, we review available literature regarding hepatitis A virus associated with pleural effusion using PubMed and summarize all reported cases in a comprehensive table.
Literature contains 20 reported cases of serology-confirmed hepatitis A virus presenting with pleural effusion, most in the pediatric population with average age at presentation of 9 years 8 months. The majority of reported patients had right-sided pleural effusion (50%) or bilateral effusion (45%), while only 5% presented with pleural effusion on the left side. Hepatomegaly and ascites occurred concurrently in 80% and 70% respectively. Supportive treatment without invasive procedures (except one chylothorax case) yielded complete recovery in 95% of cases, while only one case progressed to fulminant liver failure followed by death.
Acute hepatitis A virus rarely presents with pleural effusion, usually following a benign course with spontaneous resolution in most patients. Pleural effusion does not change the prognosis or require any invasive treatment. Thus, further invasive procedures are not recommended and would only complicate this self-resolving benign condition.
甲型肝炎病毒感染大多无症状或症状轻微，一般来说，该病具有良性病程并可自行缓解。然而，肝内和更罕见的肝外表现可能使典型的急性肝炎病例复杂化。胸腔积液是一种极其罕见的肝外实体，文献中报告了 20 例。
我们在此报告一例中东 5 岁儿童近期甲型肝炎感染同时伴有胸腔积液和腹水的病例，通过血清学检测和影像学研究诊断，采用支持性治疗，2 周后完全缓解。此外，我们使用 PubMed 回顾了甲型肝炎病毒相关胸腔积液的现有文献，并在一个综合表中总结了所有报告的病例。
文献中包含 20 例经血清学证实的甲型肝炎病毒感染合并胸腔积液的病例报告，大多数发生在儿科人群中，平均发病年龄为 9 岁 8 个月。报告的大多数患者有右侧胸腔积液（50%）或双侧胸腔积液（45%），而只有 5%的患者左侧胸腔积液。肝肿大和腹水分别同时发生在 80%和 70%的患者中。95%的患者采用支持性治疗而非侵入性操作（除 1 例乳糜胸外）完全恢复，只有 1 例进展为暴发性肝衰竭并随后死亡。
急性甲型肝炎病毒很少引起胸腔积液，通常在大多数患者中具有良性病程并可自行缓解。胸腔积液不会改变预后或需要任何侵入性治疗。因此，不建议进一步进行侵入性操作，因为这只会使这种自限性良性疾病复杂化。
